Should We Follow the ‘Rules’?

Clinical prediction rules are tools that help physicians manage patient care. However, this is a "guide" and should be considered as such. 

It's challenging to place a patient with specific needs into a prediction tool and expect all criteria to match. There is significant variability between individuals; each symptom and functional mobility presents differently as settings and daily activities constantly vary. Patients may also respond differently to various interventions, complicating the decision-making process when developing treatment plans.

Case-control design, differential verification, and inadequate sample size create flaws and are inconsistent with methodological standards (Childs et al., 2006). The Childs et al. study also indicates how clinical prediction tools can impact the clinical decision-making of physiotherapists and its influence on elements such as healthcare costs and efficiency. While these guidelines can help lead a treatment plan, they may require more than one clinical prediction rule guideline.

Does your patient fall into multiple clinical prediction rules/classification systems?

It's not uncommon to see a patient with low back pain meet the clinical prediction rule for both spinal manipulation and stabilization programs. Currently, there is only one validated clinical prediction rule for spinal manipulation (Stanton et al., 2010).

When using clinical prediction rules to treat patients, there are many factors to consider. While clinical prediction rules are helpful, other diagnostic components such as imaging, subjective information, and considering other diagnostic and treatment guidelines variables will provide better results (Sanders et al., 2015). Nevertheless, clinical prediction rules may provide support to our clinical decisions. Nevertheless, additional research is needed.